A bursa is a thin sac of connective tissue filled with the body's own natural lubricating fluid. This lubricating sac allows various tissues such as muscle, tendon, and skin slide over the bone surfaces without catching. The bursas (bursae) are very thin, but they do present a potential site that can become inflamed and irritated. This condition is called 'bursitis'. If inflammation of Bursa is associated with a break in the skin and trauma, the bursa can become infected, this is called infected bursitis and may form absesses causing excruciating pain..

Bursae arise at various joints throughout the body, such as the shoulder, elbow and knee. There are many bursas in the knee:

In front of and behind the kneecap.

On both sides of the knee.

Behind the knee (Baker's cyst).

Just above the knee (popliteal bursa).

Housemaids knee is a common name given to prepatellar bursitis or knee bursitis. Prepatellar bursitis is the inflammation of the subcutaneous prepatellar bursa, which can either be an acute (sudden onset) injury or chronic (longer term) injury. This bursa lies in front of the patella or kneecap. Under normal conditions its function is to reduce the friction between the patellar tendon and overlying skin f this bursa .which can either be an acute (sudden onset) injury or chronic (longer term) injury.

This inflammation, as the common name suggests, can be caused by prolonged work performed on the knees. This type of bursitis can affect roofers, carpet layers, miners, plumbers amongst other groups who kneel for long periods. Bursitis may also cause another condition of slow accumulation of fluid in the knee commonly called 'water on the knee'. Arthritis and gout are also associated with prepatellar bursitis, along with unknown causes (frequently).

Another cause of a swollen knee, as mentioned above, can be caused following an injury. If the swelling appears immediately after the injury the swelling is often an accumulation of blood within the joint called 'hemarthrosis'.

Symptoms of Prepatellar Bursitis include:

Kneecap may be swollen and warm to the touch

Pain and tenderness on the kneecap and just below it, especially when moving the knee

Redness (sometimes) over the affected bursa

Fever if infection is present

Limitation of motion in the knee

Difficulty kneeling

An abscess or fluid filled lump may be visible over the patella

For chronic prepatellar bursitis, there may be a tender lump floating underneath the skin on the kneecap

Soft tissue surrounding the knee, including nerves, tendons, ligaments, blood vessels (both large vessels and capillaries), periosteum (the outside lining of bone) and muscles may also be involved

Treatment of Prepatellar Bursitis at home:

Avoiding aggravating movements such as kneeling

If these cannot be avoided then knee pads or padded knee supports should be worn.

P.R.I.C.E. (protect, rest, ice, compression, elevation) technique.

Use frequent ice massage. Fill a large styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, before workouts or competition

Whenever possible, elevate the knee above the level of the heart to reduce swelling and prevent accumulation of fluid. Use pillows for propping or elevate the foot of the bed

Gentle massage will frequently provide comfort and decrease swelling

Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your chiropractor may suggest vitamin and mineral supplements to promote healing

Chiropractic Care of Housemaid's Knee:

Dr. Pisarek is certified in providing Laser therapy, which has proven to be extremely affective in management of prepatellar bursitis

Your chiropractor may provide physiotherapy treatments and exercises to make the muscles and tendons of your knee, thigh, and calf stronger after the bursitis has healed.

Your chiropractor may use ultrasound to increase blood flow to the injured area. This may help bursitis heal faster. Also, massage may be used to stretch the tissue and bring heat to the injury, which increases blood flow. This can help your knee heal faster and better.

You may slowly increase the amount of weight you put on your leg when your chiropractor says it is OK. You will be told to stop doing any activity or exercise if you feel any pain

Medical Management

Taking NSAID's such as Ibuprofen for acute episodes

If the swelling persists, then a medical professional may aspirate (suck off) some of the fluid within the bursa.

In cases where the bursa has become infected, anti-biotics may be prescribed

In more serious cases the bursa may be completely removed by surgical procedures.

Treatment Of Housemaids Knee using Natural Methods (Check with a health professional first before taking herbal remedies):

Glucosamine: Glucosamine is a form of amino sugar that our bodies naturally manufacture. It is considered one of the major building blocks for joint protection. It is usually found in conjunction with chondroitin sulfate, and is widely used to relieve pain and inflammation in such health problems of back ache, tennis elbow, and housemaids knee.

Chondroitin Sulfate: Chondroitin sulfate is also naturally found in the body. It prevents other body enzymes from degrading the building blocks of joint cartilage.

MSM: Is the shortened form of methylsulfonylmethane. MSM provides sulfur, which is a vital building block of joints, cartilage, skin, hair and nails. It also supports the production of energy. It helps normal re-building of connective tissue.

Devils Claw: Devils claw has been shown to be effective in reducing inflammation and pain in such problems of arthritis and bursitis, during clinical trials. This should not be taken by people with stomach ulcers.

Turmeric: Turmeric has been shown in clinical studies to be as effective as some NSAIDs, without the unpleasant side effects. High doses of turmeric should not be taken if the user suffers intestinal problems.

White Willow Bark: The active ingredient in willow bark is salicin. Records show people have been using willow bark since the time of Hippocrates in 400 B.C. It is used to ease discomfort.

It appears that for mild bursitis natural remedies are well worth giving consideration. Pharmaceutical drugs are preferred for more severe pain but have many more unpleasant side effects.

Prevention Tips

Always warm up your muscles and stretch gently before exercising. Do cool-down exercises when you are finished. This will relax and loosen the muscles and tendons in your thigh and calf which will decrease stress on your knees.

Wear warm clothing in cold weather.

To prevent recurrence, continue to wear extra knee pads until healing is complete.

Our patient forms are available online so they can be completed in the convenience of your own home or office.

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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.